Healthcare Provider Details

I. General information

NPI: 1346014883
Provider Name (Legal Business Name): F5 PROJECT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2023
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 1ST AVE N
FARGO ND
58102-4604
US

IV. Provider business mailing address

1122 1ST AVE N
FARGO ND
58102-4604
US

V. Phone/Fax

Practice location:
  • Phone: 701-210-2491
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CODY BENARD STANLEY
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 701-388-4550